Abstract
BackgroundDrug overdose accounts for most of the admissions to the emergency department. Prescription drugs, most of which are psychotropic medications, are often misused for drug overdose. The purpose of this study was to investigate the association between overdose in patients transported with disorders of consciousness and psychotropic medications administered prior to transport, so as to enable quick differentiation of drug overdose patients from patients with disorders of consciousness.MethodsWe evaluated 222 patients transported to the Advanced Critical Care Center of Teikyo University Hospital due to disorders of consciousness. The patients were categorized into two groups: overdose group (n = 128) and control group with other disorders of consciousness (n = 94). Logistic regression models were used to assess the association between disorders of consciousness due to drug overdose and psychotropic drugs prescribed before emergency transportation based on sex and age.ResultsAccording to multivariate logistic regression analysis, only female sex (odds ratio [OR] 4.54, 95% confidence interval [CI] 2.43–8.05, P < 0.0001) was associated with overall overdose. Results from the univariate logistic regression analysis showed that in the group of patients aged 40–50 years, female sex (OR 4.36, 95% CI; 1.54–12.4, P = 0.006) and the use of psychotropic drugs (OR 5.05, 95% CI; 1.75–14.6, P = 0.003), benzodiazepines (OR 4.64, 95% CI; 1.61–13.4, P < 0.05), antidepressants (OR 11.4, 95% CI; 2.35–55.8, P = 0.003), and anticonvulsants (OR 4.46, 95% CI; 1.11–17.9, P = 0.035) were associated with overdose. According to multivariate logistic regression analysis, female sex (OR 4.44, 95% CI; 1.37–14.3, P = 0.013) and antidepressants (OR 7.95, 95% CI; 1.21–52.1, P = 0.031) were associated with overdose patients aged 40–50 years.ConclusionsAs a reference in distinguishing overdose in women in their 40s and 50s who present with impaired consciousness, attention may need to be paid to the type of psychotropic drug used, especially antidepressants.
Highlights
Drug overdose accounts for most of the admissions to the emergency department
We investigated the association between drug overdose in transported patients with consciousness disorders and psychotropic medications administered before emergency transportation
According to multivariate logistic regression analysis (Table 2), female sex was associated with overall overdose
Summary
Prescription drugs, most of which are psychotropic medications, are often misused for drug overdose. The drugs prescribed by physicians, especially psychotropic drugs, such as benzodiazepine receptor agonists (BZs) and antidepressants [4,5,6], are misused by these patients for drug overdose. BZs have been reported to be the most common psychotropic drugs with a tendency for overdose [8] and are associated with an increased risk of suicide [9,10,11]. It has been reported that as with abuse of illegal drugs, such as stimulants, the use of BZs is associated with certain patient characteristics, including younger age and female sex [12]. There are reports of iatrogenic suicidal effects of antidepressants [21, 22] as well as the potential lethality of antidepressant overdose [23]
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